Differentiation of colonic polyps by confocal laser endomicroscopy
发表时间：2011-02-18 10:18
Background and study aim: The real-time identi- fication and removal of adenomas is a cost-effec- tive strategy to improve the prognosis of colorec- tal cancer. Confocal laser endomicroscopy (CLE) could provide real-time histological-level obser- vation. We aimed to evaluate the efficacy of CLE diagnosis using a simple classification system that differentiates adenomas from non-neoplastic polyps with intravenous fluorescein staining alone. Patients and methods: An endoscope integrated confocal laser microscopy system was used in this study. CLE images of 35 colonic polyps, in- cluding 15 hyperplastic polyps and 20 adenomas confirmed by histology, were first evaluated to develop criteria for diagnosis of neoplastic and non-neoplastic polyps. The diagnostic criteria in- cluded goblet cell depletion, villous architecture, and microvascular alterations. We then per- formed a prospective study of colonic polyps found during CLE and classified them according to the established criteria. A total of 115 patients with 115 colonic polyps were included. The real- time CLE diagnosis was compared with that from histology. The stored CLE images were evaluated later by a blinded observer. Results: The sensitivity, specificity, positive pre- dictive value, and negative predictive value of real-time CLE in identifying colonic adenomas were 93.9% (95% confidence interval [CI] 85.4– 97.6), 95.9% (95% CI 86.2–98.9), 96.9% (95% CI 89–99), and 92.2% (95% CI 81–97), respectively, compared with histological results. Interobserver agreement between real-time and post-CLE still- image evaluation was excellent (kappa =0.929). Goblet cell depletion alone had a sensitivity of 84.9% (95% CI 73–92) and a specificity of 87.8% (95% CI 75–95), as well as excellent interobserver agreement (kappa =0.824). Conclusions: Endoscope integrated CLE with fluorescein staining may reliably assist in the real-time identification of colonic adenomas. Among three diagnostic categories, goblet cell de- pletion can be used to distinguish adenomas and hyperplastic polyps.
第一署名医院：山东大学齐鲁医院；山东省青岛市立医院
Differentiation of colonic polyps by confocal laser endomicroscopy （查看pdf）
